Orientation Lecture: Introduction to Anesthesiology

Question 1

Why is thiopental not used anymore?

Answer 1

It is used in lethal injections. The company that makes it is in Italy, and when the EU switched to being against the death penalty it banned its production.

Question 2

What is the advantage of succinylcholine over the curare-derived drugs?

Answer 2

It is fast and therefore useful in rapid-sequence intubation. RSI is when a person has a full stomach and needs to be intubated. You need to work quickly to avoid aspiration.

Question 3

Discuss how the mortality of anesthesia has changed since 1950.

Answer 3

• 1950: 1 in 1,500 people who received anesthesia died due to anesthesia
• 2000: 1 in 250,000 people who received anesthesia died due to anesthesia

Question 4

Describe Bier’s block.

Answer 4

Injection of local anesthetic into a vein causes distal numbness in an extremity.

Question 5

Which kind of local anesthetics are more likely to cause allergic reactions?

Answer 5

The esters –novocaine, cocaine… all those with only one “I”

The amides –lidocaine, bupivacaine –are less likely to cause an allergic reaction.

Question 6

The most cardiotoxic neuraxial anesthetic is _____________.

Answer 6

bupivacaine

“BUPivacaine BUmPs the pUmP!”

Question 7

To insert an epidural, you poke through the ________________.

Answer 7

ligamentum flavum

Question 8

What do you need to ask a patient prior to intubation (in a preop history)?

Answer 8

• Previous trouble with airway access
• Diagnosis TMJ (jaw clicks?)
• O2 requirements
• Exercise tolerance
• Cardiovascular / pulmonary history
• Other comorbidities
• Problems with anesthetics

Question 9

Review the PE for an anesthesia preop visit.

Answer 9

• Mouth opening
• Thyromental distance (chin-to-thyroid-cartilage distance when neck is extended)
• Airway class
• Neck extension
• Jaw mobility
• Palate (arched predicts a more difficult airway)
• Dentition

Question 10

No teeth makes _____________ difficult but __________ easy.

Answer 10

bag mask; intubation

Question 11

Why does not having teeth make mask ventilation difficult?

Answer 11

Lacking teeth makes your lower jaw recede and the bone atrophy, which removes the framework on which the soft tissue clings.

Question 12

Views of the airway are __________, not scored.

Answer 12

graded

• I: whole vocal cords are seen and arytenoids
• II: posterior vocal cords are seen
• III: almost no vocal cords are seen
• IV: cannot see the airway